Immunization Delivery

Summary: Primary care providers deliver the majority of vaccines in this country and are a critical source of information regarding the feasibility and acceptability of new or changing vaccination recommendations. This project will provide a mechanism for obtaining rapid turnaround information about provider knowledge, attitudes and beliefs regarding immunization challenges on a national level. These data will be presented at ACIP meetings and will assist the CDC in making policy recommendations about new vaccines, in developing strategies to improve vaccination coverage and in planning for urgent immunization problems that arise, such as vaccine supply shortages or vaccine safety issues.

Summary:Our pilot testing found this P3 (Practice, Provider, and Patient) intervention to be well received by providers and patients and indicated a few areas where the intervention could be improved. In this project, we develop and evaluate an improved version of the P3 intervention, to be called P3+. Improvements to the initial P3 framework are based on findings from the original evaluation project as well as additional formative research. We will then evaluate the P3+ intervention in a geographically and socio-demographically diverse set of obstetriciangynecologist offices in Georgia (community-level practices) and Colorado (offices of the Kaiser Permanente Colorado managed care organization). The research will be lead by Multiple PIs who have extensive experienced in understanding and addressing barriers to vaccine uptake.

Summary:Our overarching goal is to evaluate the effectiveness, cost-effective and sustainability of IIS R/R performed at the county-wide level in improving HPV vaccination rates. We will extend our previous research on effectiveness of centralized R/R to a new population--adolescents due for HPV vaccine-- and test the use of centralized R/R as a cancer-prevention strategy. We will also assess the impact of adding mailed R/R to the phone R/R protocol and the impact of centralized R/R for key patient subgroups. We will assess the effect of centralized R/R in two states--one with and one without mandated reporting of vaccinations to IISs, and disseminate IIS R/R to other states. We will implement, evaluate (using the RE-AIM framework31-36), and disseminate a collaborative, IIS-based centralized HPV vaccine R/R model in which partnerships of public health systems and primary care practices in two states (NY, CO) collaborate to remind parents about HPV vaccination.

Summary: We have united two of the nation’s leading immunization research groups to assess the impact of centralized IIS-based influenza vaccine R/R. Our groups have performed seminal studies on practice-based R/R for influenza and other vaccines. Our CO team has shown, in a pragmatic, population-based trial, that centralized IIS-based R/R was more effective and cost-effective than practice-based R/R for increasing routine immunizations (not including flu vaccine) in young children.16 NY and CO are states with two prevalent models of child influenza vaccine delivery-NY where virtually all influenza vaccines are delivered in 1º care offices and CO where pharmacies deliver many influenza vaccines. Therefore, we will implement, rigorously evaluate, and disseminate a centralized IIS influenza vaccine R/R system to boost flu vaccine rates in 2 contrasting states. We will develop tools to aid other states in creating efficient IIS R/R systems in preparation for both seasonal and possible pandemic influenza outbreaks. Based on previous work, we expect the impact of this R/R approach to be high, with rapid increases of at least 10% in population influenza rates at a low cost.

Summary: The Institute of Medicine recently highlighted the importance of creating partnerships between accountable care organizations (ACO) and public health entities in order to broaden the scope and efficiency of delivering clinical preventive services to populations. This proposal focuses on implementing and evaluating an evidence-based collaborative method of increasing immunization rates among preschool children, adolescents and adults within an ACO-Public Health collaborative. The infrastructure we will create around immunizations will serve as the framework for future collaborative delivery of other preventive services.

Summary: Primary care providers deliver the majority of vaccines in this country and are a critical source of information regarding the feasibility and acceptability of new or changing vaccination recommendations. This project will provide a mechanism for obtaining rapid turnaround information about provider knowledge, attitudes and beliefs regarding immunization challenges on a national level. These data will be presented at ACIP meetings and will assist the CDC in making policy recommendations about new vaccines, in developing strategies to improve vaccination coverage and in planning for urgent immunization problems that arise, such as vaccine supply shortages.

Funder:CDC/NCIRD

Award Number:5U01IP000849​

Project Period:09/01/2017-08/31/2018​​Title: The REDIVAC Study – Reducing Delay in the Vaccination of Children Study

Summary: Interventions to reduce infant under-vaccination are needed to counteract the increasing number of vaccine-preventable disease outbreaks. Our intervention is designed to be delivered to mothers during the most critical time in their vaccination decision-making, without placing an increased burden on clinicians or the clinical encounter. Because of this, and the fact that our intervention is web-based, it has the capacity to be implemented on a large scale for relatively little cost, and could therefore become an important public health tool with a substantial potential to reduce the incidence of vaccine-preventable diseases.

Summary:If our intervention proves efficacious it could have a significant public health benefit by decreasing adolescents’ risk for the sequelae from HPV infection. Because our communication-based intervention may impact provider communication about adolescent vaccines more broadly, it may also potentially impact adolescent Tdap, MCV and Flu vaccine utilization. By designing our intervention to facilitate provider-parent communication about vaccines throughout the continuum of the vaccine decision-making process, and incorporating significant provider feedback into the intervention components, our intervention is more likely to be acceptable, feasible and sustainable across a variety of clinical practice types and patient populations.

Summary:The
focus of this project works to improve HPV vaccination among Latinas, who
have the highest risk for
developing invasive cervical cancer compared to all other racial/ethnic groups.
The long-term objective of this
research is to compare 3 different educational approaches to informing HPV vaccine decision-making
among Latinas. The
Aims of the study are to: Culturally tailor an
existing decision-support tool about HPV vaccines to the informational needs of
Latinas, compare the impact of
the culturally tailored tool to an untailored tool and to the “standard of
care” on patient-centered outcomes related to the vaccination decision, and compare the impact of
these approaches on Latina HPV vaccine use.​ This project is in peer review.